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Core Imaging Facility User Registration Form

 
First Name*:
Last Name*:
E-Mail*:
EM Facility use:
Confocal Facility use:
UMB ChartString PCBU*:
ProjectID*:
Department*:
School*:
Other affiliation:
PI (Last,First)*:
Room:
Building:
Number, Street*:
City:
State:
Zip:
Country:
Office (tel)*:
Lab(Tel):
Cell:
Fax:
ProxCard Number:

* Required Fields.

All UMB users must provide PCBU and Project ID for billing purpose.

The 5-digit UMBOne card number is show, circled in red on the back of your UMBOne card.

UMBOne proxcard Number